Page 65 - JSOM Spring 2020

High Reliability. Consistent Performance. An Inventory of the Combat Medics’ Aid Bag

Steven G. Schauer, DO, MS ; Jason F. Naylor, PA-C ; Nguvan Uhaa, LPN ;
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Michael D. April, MD, DPhil, MSc ; Robert A. De Lorenzo, MD, MSM, MSCI 5
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ABSTRACT
Introduction: Tactical Combat Casualty Care (TCCC) recom- Introduction
mends life-saving interventions; however, these interventions
can only be implemented if military prehospital providers Background
carry the necessary equipment to the injured casualty. Combat The TCCC guidelines are a set of evidence-based, prehospital
medics primarily use aid bags to transport medical materiels trauma management recommendations specifically designed
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forward on the battlefield. We seek to assess combat medic for the austere, combat setting. Military armed conflict in-
materiel preparedness to employ TCCC-recommended inter- troduces numerous factors not encountered in civilian trauma
ventions by inventorying active duty, combat medic aid bags. medicine that must inform and influence medical management
Methods: We sought combat medics organic to combat arms expectations placed on military prehospital providers, namely
units stationed at Joint Base Lewis McChord. Medics volun- combat medics. In particular, “equipment must be simple, light,
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teered to complete a demographic worksheet and have the and rugged.” A life-saving intervention may be rendered use-
contents of their aid bag photographed and inventoried. We less if it cannot be carried to battlefield casualties and effectively
spoke with medic unit leadership prior to their participation administered by combat medics, potentially under hostile fire.
and asked that the medics bring their aid bags in the way they
would pack for a combat mission. We categorized medic aid Front-line, combat medics have few options to transport med-
bag contents in the following manner: (1) hemorrhage con- ical materiel to the point of injury. The primary method uti-
trol; (2) airway management; (3) pneumothorax treatment, lized by combat medics are aid bags, or backpacks worn over
or (4) volume resuscitation. We compared the items found in the uniform and body armor where size and weight are of the
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the aid bags against the contemporary TCCC guidelines. Re- utmost importance. Excessive size and weight increase physi-
sults: In January 2019, we prospectively inventoried 44 com- cal exertion and limits mobility, especially in hostile situations
bat medic aid bags. Most of the medics were male (86%), in where rapid mobility is of the highest importance. The US
the grade of E4 (64%), and had no deployment experience Army currently fields the M9 medical bag and several com-
(64%). More medics carried a commercial aid bag (55%) than mercial vendors offer variations of aid bags and self-contained
used the standard issue M9 medical bag (45%). Overall, the litter kits—in addition to smaller pouches that are worn on
most frequently carried medical device was an NPA (93%). the thigh or attached to body armor—that combat medics may
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Overall, 91% of medics carried at least one limb tourniquet, use. In addition to the size and weight limitations, medics can
2% carried a junctional tourniquet, 31% carried a supraglot- carry only what is logistically available. Multiple, previously
tic airway (SGA), 64% carried a cricothyrotomy setup/kit, published military studies attribute medical materiel shortfalls
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75% carried a chest seal, and 75% carried intravenous (IV) to the deployed, medical logistical system.
CONSISTENT HEMOSTASIS ACHIEVEMENT IN HUMANS fluid. The most commonly stocked limb tourniquet was the
Hemostatic dressing with the most C-A-T (88%), the airway kit was the H&H cricothyrotomy Despite more than two decades of TCCC and numerous pub-
lished studies related to TCCC, there are no published data that
peer-reviewed (Military & Civilian) kit (38%), the chest injury set were prepackaged needle de- describe and evaluate the combat medic aid bag and its capac-
compression kits (81%), and normal saline was the most fre-
published clinical literature. 4 quently carried fluid (47%). Most medics carried a heating ity to facilitate TCCC-recommended, life-saving interventions.
blanket (54%). Conclusions: Most medics carried materiels
that address the common causes of preventable death on the Goal of This Investigation
See us at SOMSA Booth #1003 battlefield. However, most materiels stowed in aid bags were We seek to assess combat medic materiel preparedness to use
to get the facts. not TCCC-preferred items. Moreover, there was a small subset TCCC-recommended interventions by inventorying active duty
of medics who were not prepared to handle the major causes combat medic aid bags.
of death on the battlefield based on the current state of their
aid bag. Methods

Keywords: combat; medic; aid bag; military We sought soldiers with the military occupational specialty
(MOS) 68W, with or without special skills identifiers, as-
www.QuikClot.com/Military signed to a brigade combat team. We asked medics with per-
MADE IN THE USA sonal aid bags (i.e., not unit issued) to bring their aid bags for
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Z-Medica 4 Fairfield Boulevard Wallingford CT 06492 USA (877) 750-0504 *Correspondence to Steven Schauer, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234 or steven.g.schauer.mil@mail.mil
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MAJ Schauer is with the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam
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Houston, TX; Uniformed Services University of the Health Sciences, Bethesda, MD; and 59th Medical Wing, JBSA Lackland, TX. LTC Naylor is
©2020 Z-MEDICA, LLC. All rights reserved. PSST-1000_Revised_1 3
References: with Madigan Army Medical Center, Joint Base Lewis McChord, WA. Ms Uhaa is with US Army Institute of Surgical Research, JBSA Fort Sam
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1. Zietlow JM, Zietlow SP, Morris DS, Berns KS, Jenkins DH. Prehospital Use of Hemostatic Bandages and Tourniquets: Translation From Military Experience to Implementation in Civilian Trauma Care. J Houston, TX. MAJ April is with Uniformed Services University of the Health Sciences, Bethesda, MD; and 4th Infantry Division, 2nd Infantry
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Spec Oper Med. 2015 Summer;15(2):48-53. 2. Schauer SG, April MD, Naylor JF, Fisher AD, Cunningham CW, Ryan KL, Thomas KC, Brillhart DB, Fernandez JRD, Antonacci MA. QuikClot Combat Gauze® Brigade Combat Team, Fort Carson, CO. Dr De Lorenzo is with University of Texas Health–San Antonio, San Antonio, TX.
Use by Ground Forces in Afghanistan The Prehospital Trauma Registry Experience. J Spec Oper Med. Summer 2017;17(2):101-106. 3. Shina A1, Lipsky AM, Nadler R, Levi M, Benov A, Ran Y, Yitzhak A,
Glassberg E. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015 Oct;79 (4 Suppl 2):S204-9. 4. Boulton AJ,
Lewis CT, Naumann DN, Midwinter MJ. Prehospital haemostatic dressings for trauma: a systematic review. Emerg Med J. 2018; 35: 449-457. 61